Laserfiche WebLink
Burnett County Office of Zoning Administrator0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3 0 <br /> TO THE ZONING ADMINISTRATOR- The undersigned hereby makes application for a Permit for the work described and located as < 7 <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. a <br /> f... .. ...... ..;... .x...s....................................... ............................................................................................ <br /> N o <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a <br /> y� K.......M .7....... .. . ..s.-.......................... ` <br /> v....... v.C..... ..1 ........................... <br /> ..............� �.. <br /> ADDRESS �ADRES o� <br /> ......................... <br /> .................................................................. ............................................................................................ n <br /> ADDRESS _ ADDRESS <br /> �T.. .. ........7..`?. .................................................. ........... P� <br /> ................................................................................. (v'� <br /> PHONE <br /> P <br /> PLUMBER WELL DRILLER <br /> ............................................................................................ <br /> ........................................................................................... .b <br /> ADDRESS ADDRESS itl :(\ <br /> o <br /> PHONE PHONE Z r <br /> DESCRIPTION 4. Sanitary Facilities: ° o <br /> 1. Work: 2. New Building Details No. Bathrooms .......... o <br /> New Building .......... Type of Constructicly— No. Bedrooms r. ` E�1 a, I4 <br /> Addition !S/�h Septic Tank Size Gals. 1........ p ,� 1 <br /> ilt <br /> Sanitary .../�... Size ft. x ft. / ?'rJ ' <br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: t p <br /> Moving .......... Area Soil Type .................................... .o <br /> Mobile Home .......... Slope .......................................... 1 r. <br /> Privy .,........ 3. Use (describe exactly, 1 -family Pere. Rate ................................... LT i <br /> Well .......... home,garage, motel, etc.) Dry Well .......... '� <br /> Subdivision .......... . . .... ...................................... Seepage Trench .......... 1�. <br /> "....' Privy `~� <br /> CampingUnit ...I...... .................................................... <br /> Seepage Bed <br /> _____________________________________________________________________ 'JJ t s <br /> Location of proposed structures and existing structures,well, sewage systems, roads, etc., should be sketched in FIg_ A. Include road 't 1 Q <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property Is located at a highway Inter- O a <br /> section, show the Intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. U� o <br /> _________________----_____________q___ ___________________ N 3 <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. - ............................... s ft. ................... ........................................................... C�) <br /> n <br /> IN o <br /> 03 g <br /> ')- 6 <br /> 1-. N <br /> s <br /> L— z <br /> o <br /> 1 f I <br /> I <br /> Z <br /> ` n yjQ a � <br /> I, °-°- � . °i m <br /> Z o o l <br /> o = n ro 3 <br /> EA = _ <br /> O <br /> va m <br /> Signature of Ow,[n�er opge-i Date o . . . . . . C <br /> Remarks ........ .. ... . ............................................................................................................................................. to <br /> term <br /> - <br /> .............�I,X.rt.1l'G.�Nlr.6..! 5.. .. ............................... ............ . .... .. ..................................... q . . . . . T <br /> ..,Q........... . . ...... `I <br /> Inspection Date Z1 -.aZ.s1...-� ........ ...... . ../,,,.... )...........�.!............. O N <br /> nYP II <br /> v iii <br /> 1 N N <br /> io O W O <br /> Zoning Administrator 8 8 8 8 8 0 <br /> NOTE. A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> this application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build <br /> mg until a permit has been issued A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> with is found to exist. Changes in plans or specifications shall not be made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />